Abstract Background This systematic review aimed to identify a comprehensive list of prescribing safety indicators for opioids in any setting from published literature. Methods Literature that reported prescribing indicators from 1990-2019 was retrieved from a published systematic review. A subsequent search was conducted from seven electronic databases to identify additional studies from 2019 to 2022. Potential opioid safety prescribing indicators were extracted from studies that reported prescribing indicators of non-injectable opioids and narcotics prescribed to adults with or without specific conditions, concomitant medications, or laboratory monitoring with concerns about the potential safety risk of harm. Retrieved indicators were split by each opioid and merged for the same drugs. Identified indicators were categorised by the type of problem, medication, patient condition/disease, and the risk of the indicators. Results Of the 107 indicators retrieved from 48 included articles, 71 were included. Thirty-five (49.3%) opioid prescribing indicators focused on a specific class of opioids, i.e., 'opioids' (n=30, 42.3%) and 'strong opioids' (n=5, 7.0%); tramadol and fentanyl were the most commonly reported drug (n=6, 8.5%). The indicators account for six types of problems: medication inappropriate to the population (n=16), omission (n=7), inappropriate duration (n=4), inadequate monitoring (n=7), drug-disease interaction (n=16), and drug-drug interaction (n=27). Of all indicators, older age (over 65) is the most common risk factor (n=34, 47.9%). Central nervous system-related adverse effects are the risk of concern for the 27 indicators associated with drug-drug interaction (n=24, 88.9%). Besides, five of the six ‘omission’ indicators are related to 'without using laxatives'.  Conclusion This review identified a comprehensive list of indicators that can be applied to flag patients with a high risk of opioid-related harm to facilitate complex decision-making in optimising opioids for pain management. Further research is needed to validate and determine the feasibility of identifying hazardous prescribing in various care settings.

The authors have declared no competing interest.

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